Two of the most common Pelvic Syndromes that occur with the Rothbarts Foot and the PreClinical Clubfoot Deformity

Piriformis Syndrome and Lumbar Nerve Syndrome

References:

   Yeoman W 1928. The relation of arthritis of the sacroiliac joint to sciatica with an analysis of 100 cases. Lancet (2):1119-1122
   Chaitow L, Walker J, 2000. Clinical Application of Neuro Muscular Techniques. Volume I, The Upper Body. Churchill Livingstone

Anterior Rotation of the Innominate places the Piriformis Muscle on a Stretch.  This can compress the Sciatic Nerve (black arrow) against the rotated tightened muscle belly of the Piriformis and result in Sciatica

Piriformis Stretch Test

Piriformis Stretch Test is used to determine if the Piriformis muscle is compressing (entrapping) the sciatic nerve against the greater sciatic notch.


Piriformis Stretch Test (for the right side):


Patient Position:  supine (lying face up), flat on back

  • Bend the right hip to 90 degrees
  • Place the left hand on the right knee and continue to bend (flex) the right hip as you bring the right knee towards the left hip, e.g., cross pattern flexion. 
  • The black arrow in the photograph below points to where the stretch must be felt.  If not, repeat this test until the stretch is felt, as indicated by the arrow.


While performing this test, it is important that:

  • the left leg is maintained in full extension
  • the back is kept flat on the floor

Interpretation of Results:

If the right sciatic pain is reduced while running this test, the right Piriformis muscle is in spasm and is compressing (entrapping) the right sciatic nerve against the greater sciatic notch (e.g., Piriformis Syndrome).

If the right sciatic pain is not reduced while running this test, the right Piriformis muscle is not compressing (entrapping) the right sciatic nerve against the greater sciatic notch.

Yeoman was the first describe piriformis syndrome in 1928.  Based on 100 case studies (patients with low back pain), Yeoman diagnosed 36 as having periarthritis involving the anterior sacroiliac ligament, the piriformis muscle and the adjacent radicals of the sciatic nerve (although Yeoman do not mention the term 'piriformis syndrome' in his original paper).

In one recent hospital study, 45 of 750 patients with low back pain were found to have piriformis syndrome.  Other studies have estimated the incidence of piriformis syndrome in sciatic patients at 6%.



Symptomatic Profile

  • Chronic pain in the buttocks (may radiate to the lower leg, increases with walking or squatting, may imitate low pack pain)
  • Pain with bowel movements
  • Pain the labia majora in women, pain in the scrotum in men
  • Dyspareunia in women
  • Pain when arising from bed
  • Pain increased with hip adduction and internal rotation
  • Intolerance to sitting


In approximately 15% of the population, the peroneal portion of the sciatic nerve passes through the muscle belly of the piriformis muscle, or the undivided sciatic nerve penetrates the belly of the piriformis muscle.   These people are more prone to develop a mechanically induced piriformis syndrome (Chaitow and Walker, 2000)